Antibiotic prescribing in medical intensive care units – a comparison between two private sector hospitals in Central India

Abstract

Background: Inappropriate antibiotic prescribing, common in India, contributes to increased risk for development of bacterial resistance. Patients admitted to intensive care units (ICUs) are often prescribed antibiotics. Paucity of local data on antibiotic prescribing hinders development of appropriate interventions. The aim of the study was to describe and compare antibiotic prescribing in medical ICUs (MICUs) at two private sector hospitals, one teaching (TH) and one non-teaching (NTH) in Ujjain, India. Methods: The study was conducted prospectively for 3 years at MICUs of both hospitals. Patients were compared for demographic variables and diagnosis, prescribed antibiotics, generic name prescribing, and route of administration. Adherence to the World Health Organization list of essential medicines (WHOLEM) and the National List of Essential Medicines of India (NLEMI) was analyzed. Results: In total, 4843 of 6141 patients admitted to the MICUs stayed at least one night. More than 70% were prescribed antibiotics. Generic name prescribing was more common at the TH than at the NTH. Prescriptions at the TH had higher compliance to WHOLEM and NLEMI compared with that at the NTH (p < 0.001). Of the 1371 patients at the TH, 189 (14%) and of 3472 at the NTH, 400 (12%) patients were diagnosed with infections. More than 75% of patients at both hospitals had no infection-associated diagnoses. Conclusions: Antibiotic prescribing was common at both hospitals. The antibiotic prescriptions at the TH had higher compliance to WHOLEM and NLEMI. However, there is a need to develop appropriate interventions to improve antibiotic prescribing at both hospitals.

Keywords::

• Antibiotic prescribing
• inpatients
• medical intensive care unit
• private sector hospitals
• teaching and non-teaching hospitals

Acknowledgments

The authors acknowledge the nurses at both hospitals for collecting the data. Thanks are due to Dr V.K. Mahadik (Medical Director) and to the management of both hospitals to permit and support the study. This study was funded by the Swedish Research Council (K2007-70X-20514-01-3) and Asia Link (348-2006-6633). M.S. is a recipient of a scholarship from Erasmus Mundus External Cooperation Window Lot-15, India. A.L.D. is a recipient of a scholarship from the Swedish International Development Cooperation Agency and the Karolinska Institutet, Sweden.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.